The Association of Inflammation with Premenstrual Symptoms

Abstract

Background: About 80% of women experience premenstrual symptoms (PMSx), and about 50% of women seek medical care for them, posing a large medical care burden. However, despite women's use of antiinflammatory agents for relief from these symptoms, and the fact that anti-inflammatory agents provide relief from some PMSx, the relationship of inflammation to PMSx has not been well investigated. Methods: We, therefore, undertook the present cross-sectional analyses using baseline data from the longitudinal Study of Women's Health Across the Nation (SWAN), a racially/ethnically diverse cohort of midlife women (n = 2939), to determine if a biomarker of inflammation, high-sensitivity C-reactive protein (hs-CRP), was associated with PMSx. We performed factor analyses with Varimax rotations to determine five groupings of eight symptoms to develop a parsimonious set of outcome variables. We conducted backward stepwise multiple logistic regression models for each grouping, eliminating non-significant ( p > 0.05) covariates. Results: Having an hs-CRP level >3 mg/L was significantly positively associated with premenstrual mood symptoms (adjusted odds ratio [aOR] = 1.27, 95% confidence interval [95% CI] 1.02-1.58), abdominal cramps/ back pain (aOR = 1.40, 95% CI 1.09-1.80), appetite cravings/weight gain/bloating (aOR = 1.41, 95% CI 1.04-1.89), and breast pain (aOR = 1.26, 95% CI 1.02-1.55). Elevated hs-CRP level was not associated with premenstrual headaches or reporting three or more PMSx. Conclusions: The significant relationships of specific groups of PMSx with elevated hs-CRP levels have potential clinical implications for treatment and possibly for prevention by advising women about the factors associated with inflammation and the potential for treatment with anti-inflammatory agents.

Premenstrual syndrome: a short review

“…Furthermore, repeated hs-CRP serum concentrations correlated significantly and positively with the symptom scores. A similar association was found in the study by Gold et al [19]. These authors found that older reproductive age women with serum level of hs-CRP higher than 3 mg/L had about 30% higher probability of premenstrual mood symptoms and 40% higher probability of abdominal cramps and back pain when compared to women with lower level of hs-CRP.…”

“…Furthermore, progesterone, due to its ant-inflammatory action, enables embryo implantation in female uterus during the pregnancy [25]. The increase of inflammatory hs-CRP and interleukins should be thus expected during the premenstrual period when progesterone level decreases, as observed in studies described above [19][20][21]. It is also possible that the low level of progesterone during the luteal phase might promote infection and inflammation which results in an increased level of inflammatory proteins such as hs-CRP and interleukins.…”

“…An alternative hypothesis about the occurrence of premenstrual symptoms comes from studies on changes in the level of high sensitivity C-reactive protein (hs-CRP) during the menstrual cycle [19,20]. This acutephase response inflammatory protein of hepatic origin increases in response to a wide range of acute and chronic inflammatory conditions.…”

It's time to redefine inflammation

“…Low‐grade inflammation has been reported to be associated with an astounding number of conditions and lifestyles felt to be associated with poor health; these conditions represent or reflect minor metabolic stresses. The lengthy (partially cited here) list includes exposure to environmental irritants such as cigarettes, secondhand smoke, sleep deprivation, low levels of physical activity, atrial fibrillation, hypertension, low birth weight, lumbar disc herniation, impaired cognition, low grip strength, polycystic ovary syndrome, living at high altitude (12, 13), prehypertension (14), obstructive sleep apnea (15), premenstrual symptoms (16), a large variety of unhealthy diets (17), hypoxia (18), social isolation (19, 20), being unmarried (21), and aging (22, 23).…”

The Uterine-Chemokine-Brain Axis: Menstrual Cycle-Associated Symptoms (MCAS) are in Part Mediated by CCL2, CCL5, CCL11, CXCL8 and CXCL10

“…24 CRP levels are positively associated with mood, behavior, pain and physical symptom severity during the menstrual cycle. 25,26 IL-2, IL-4, IL-10, IL-12, and interferon-gamma (IFN-) are also associated with emotional and physical symptom in women with PMS 27 whereby levels of IL-12 and IFN- are more than twice as high in PMS as compared with controls. Nevertheless, there are no studies whether changes in chemokine levels are associated with menstrual cycle symptoms.…”